HomeMy WebLinkAboutAPPLICATION - 05-00463 - Premier Powder Coating - Mechanical~'~' OF REXB URG ~
BUILDING PERMIT APPLICATION Ple
PFR1\~TTT ~f
19 E MAIN, REXBURG, ID. 83440 If tb (h` OU-~fi3
208-359-3020 X322 Premier Po~~rder Coating-Mechanical
PARCEL NUMBER:
SUBDIVISION: - UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
on!
cable
OWNER NAME: (.~~~! 1r. -fit I CONTACT PHONE #
PROPERTY ADDRESS: 1 l , ~ ~ `~~~ ~ e
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) -Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS: CITY ~... QG-~r STAT_ZIP
PHONE: Home# i Work# ~ _ ~~ ` '~-L t~ Cell#
EMAIL FAX ,%r~ ..r-~ .
now many nuuamgs are Iocatea on this property'!,
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify
that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me
in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply
with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter
upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions of the 2000 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
~ ., a.
-.,~. ~ ~_
Signat of e plicant DATE
Do yo er to be contacted b fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January 1.2005.
City of Rezburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
.:.~...
"Tease
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
a
question does not apply fill in NA for non
Permit#
Required!!!
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MECHANICAL
Mechanical Contractor's Name: ~ -E-~p~' Business Name: (~~{ ~EL~J~~~
Address ~Z ~ City 1~se~~ia~_.nP~a State Zip $
Contact Phone: (?,~ ~~~o-~ht• [ Business Phone: (~ ~5(p--d-t. ~ [
Email
Fax C,2o~S1 vim- c,~r
Mechanical Estimate $~ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
_~_ Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Sig tore of Licensed Cc tractor
The City of RexburQ's
~~
License number
schedule is the same as
~o ~ er2~
Date
by the State of Idaho